File Number

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	ACT CIVIL AND ADMINISTRATIVE TRIBUNAL

GOODS APPLICATION- 
CIVIL DISPUTE

APPLICANT’S DETAILS	
Name	 
	
Address line 1	
 	
Address line 2	
 	
Telephone:	Mobile:                                                   H:                                 W:	
Email:	                                                               	 Fax:	
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
APPLICANT’S REPRESENTATIVES DETAILS (IF ANY)	
Name:	 
 	
Address line 1	 	
Address line 2		
Telephone:	Mobile:                                                   H:                                 W:	
Email:		  Fax:	
RESPONDENT’S DETAILS	
 Name		
Address line 1		
Address line 2		
If a corporation:

ACN/ABN

Address of registered officer/public officer		
		
Telephone:	Mobile:                                                   H:                                 W:	
Email:			 Fax:	

Order Sought:	

	

	

	

	
	
Grounds relied on: (if not enough space, please provide attachments)	

	

	

	

	

	

Attempts to resolve matter:	

	
*The applicant and respondent have made no prior attempts to resolve their disputes	

DETAILS OF AMOUNTS CLAIMED	
Amount	 Reason claimed	
 	Fee for commencing proceedings	
	Charges and out-of-pocket expenses	
	Amount claimed for value of goods and services (if any)	
	Amount of damages sought for detention of goods (if any)	
	If any other amount claimed- specify amount sought	
	Particulars of Interest:
Interest to be determined by the Tribunal is claimed in accordance with the Court Procedures Rules 2006.

Period(s) for which interest is claimed

Contractual interest is claimed:

Period(s) for which interest is claimed

Total amount of interest accrued to date	
	TOTAL AMOUNT OF APPLICATION	

Applicant’s Signature			Date		

INFORMATION ABOUT GOODS APPLICATIONS

This Application form should be used for applications to the ACT Civil and Administrative Tribunal (the ACAT) for goods applications. 

A ‘goods application’ is an application dealing with the provision of goods and services. You can make a goods application for the recovery of the value of goods or services, for the recovery of goods, for the provision of services or for damages caused by the detention of goods.

Other applications should be lodged in person between the hours of 9am and 4.30pm at the ACAT, Level 4, ACT Health Building, 1 Moore Street, Canberra City or by mail to GPO Box 370, Canberra ACT 2601 or by fax to (02) 6205 4855